ICIA PTO Monthly Continuous Donations (Non Membership)

Irvine Chinese Immersion Academy PTO Monthly Continuous Donation Form (Non Membership)

1 Liberty

Irvine, CA 92620

EIN: 93-2660642

Item Description			Price	Qty
Parent Name Child Name #1 Child Name #2 Child Name #3 Child Name #4
	Monthly Reoccurring Donations to ICIA PTO		One-timeRecurring $ Number of payments